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April 29, 2014 — JAMA Internal Medicine has published a study linking high-dose antidepressant use in children to a doubled risk of self-mutilation behavior, including suicide attempts.

The study was led by Dr. Matthew Miller from the Harvard School of Public Health and colleagues. Conclusions were based on data from over 162,000 individuals aged 10-64 who were diagnosed with depression and prescribed Celexa (citalopram), Zoloft (sertraline), or Prozac (fluoxetine). They were monitored at one month, three months, and one year for self-harm or suicidal behavior.

The “modal dose” was defined as 20-mg/day for Celexa, 50-mg/day for Zoloft, and 20-mg/day for Prozac. For patients aged 10-24 years old, these doses did not correspond with an increased risk of self-harm behavior. However, self-harming behaviors were 2.2-times more common in patients who received higher than the modal dose, especially during the first three months of treatment. No change in suicide risk was seen in the 25-64 age group at higher doses.

According to the researchers:

“In our primary analysis of the 10- to 24-year-old cohort, for every 1000 patients initiating high-dose therapy there were approximately 7 (7.3) more [deliberate self-harm] events over the first 90 days of treatment among high-dose initiators compared with modal dose initiators.”

The link between antidepressants and suicide has been known for over a decade. In 2004, the U.S. Food and Drug Administration (FDA) required a Boxed Warning label about the risk. Even so, antidepressants are used by an estimated 3.7% of children aged 12-17, according to the Centers for Disease Control and Prevention (CDC). About 1 in 10 Americans aged 12 and over used an antidepressant between 2005-2008.


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